Prevalence and factors associated with uptake of voluntary medical male circumcision services among men aged 25-39 years in Rakai, Uganda

Abstract

Despite significant advances, the global challenge of controlling HIV/AIDS remains, especially in sub-Saharan Africa, which is home to two-thirds of those living with HIV. Uganda’s HIV prevalence stands at 5.8%. To curb transmission, the WHO recommends combination prevention strategies, including voluntary medical male circumcision (VMMC), a cost-effective approach. Engaging men aged 25 and above, who play a significant role in HIV transmission, has proven challenging in Uganda. Currently, 57.5% of Ugandan men aged 15–49 have taken up VMMC, with most uptake among adolescents. Cultural norms, misconceptions, and perceived risks hinder uptake among older men, yet few studies have explored these barriers in Uganda. Objective: This study sought to determine factors influencing VMMC uptake and explore motivators and barriers for men aged 25–39 in Rakai district, aiming to inform targeted HIV prevention efforts. Methods: Using a concurrent mixed-methods design, the study analyzed secondary quantitative data from 2,317 men aged 25–39 from the Rakai Community Cohort survey from Decemeber 2020 to March 2023. The modified Poisson model in STATA v14 was employed to determine factors associated with VMMC uptake, while qualitative data from 21 in-depth and key informant interviews was analyzed in atlas.ti to provide insights into motivators and barriers to uptake. Results: Voluntary medical male circumcision uptake among men aged 25–39 was 64.1%, lower than the 79.2% among younger men aged 15–24. Factors linked to uptake included being older than 35 years, having 2 or mor sexual partners in 12 months, never using condoms, and never having tested for HIV. Key motivators were STI prevention and improved hygiene. Barriers included work-related time constraints, pain, delayed healing, and limited communication targeting older men. Conclusion: The uptake of VMMC among men aged 25–39 in Rakai remains suboptimal, despite their key role in HIV epidemic control. Implementing communication strategies such as one-to one engagements preferred by older men and modifying the VMMC service to address concerns of loss of working time may increase VMMC uptake among older men to acceptable levels.